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. 2024 Mar 1;25(3):200-209.
doi: 10.2459/JCM.0000000000001582. Epub 2024 Jan 9.

Characteristics and outcomes of patients with tricuspid regurgitation and advanced heart failure

Matteo Pagnesi  1 , Mauro Riccardi  1 , Mauro Chiarito  2   3 , Davide Stolfo  4 , Luca Baldetti  5 , Carlo Mario Lombardi  1 , Giada Colombo  1 , Riccardo Maria Inciardi  1 , Daniela Tomasoni  1 , Ferdinando Loiacono  2 , Marta Maccallini  2   3 , Alessandro Villaschi  2   3 , Gaia Gasparini  2   3 , Marco Montella  2   3 , Stefano Contessi  4 , Daniele Cocianni  4 , Maria Perotto  4 , Giuseppe Barone  5 , Marco Merlo  4 , Alberto Maria Cappelletti  5 , Gianfranco Sinagra  4 , Daniela Pini  2 , Marco Metra  1 , Marianna Adamo  1
Affiliations

Characteristics and outcomes of patients with tricuspid regurgitation and advanced heart failure

Matteo Pagnesi et al. J Cardiovasc Med (Hagerstown). .

Abstract

Aims: To evaluate the role of tricuspid regurgitation in advanced heart failure.

Methods: The multicenter observational HELP-HF registry enrolled consecutive patients with heart failure and at least one 'I NEED HELP' criterion evaluated at four Italian centers between January 2020 and November 2021. Patients with no data on tricuspid regurgitation and/or receiving tricuspid valve intervention during follow-up were excluded. The population was stratified by no/mild tricuspid regurgitation vs. moderate tricuspid regurgitation vs. severe tricuspid regurgitation. Variables independently associated with tricuspid regurgitation, as well as the association between tricuspid regurgitation and clinical outcomes were investigated. The primary outcome was all-cause mortality.

Results: Among the 1085 patients included in this study, 508 (46.8%) had no/mild tricuspid regurgitation, 373 (34.4%) had moderate tricuspid regurgitation and 204 (18.8%) had severe tricuspid regurgitation. History of atrial fibrillation, any prior valve surgery, high dose of furosemide, preserved left ventricular ejection fraction, moderate/severe mitral regurgitation and pulmonary hypertension were found to be independently associated with an increased likelihood of severe tricuspid regurgitation. Estimated rates of 1-year all-cause death were of 21.4, 24.5 and 37.1% in no/mild tricuspid regurgitation, moderate tricuspid regurgitation and severe tricuspid regurgitation, respectively (log-rank P < 0.001). As compared with nonsevere tricuspid regurgitation, severe tricuspid regurgitation was independently associated with a higher risk of all-cause mortality (adjusted hazard ratio 1.38, 95% confidence interval 1.01-1.88, P = 0.042), whereas moderate tricuspid regurgitation did not.

Conclusion: In a contemporary, real-world cohort of patients with advanced heart failure, several clinical and echocardiographic characteristics are associated with an increased likelihood of severe tricuspid regurgitation. Patients with severe tricuspid regurgitation have an increased risk of mortality.

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